Chapter 5Chapter 5

Common Aging ChangesCommon Aging Changes

NURS 4100 Care of the Older Adult

Spring 2014

Joy Shepard, PhD(c), MSN, RN, CNE, BC

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ObjectivesObjectivesObjectivesObjectives•List common age-related changes at the

cellular level; in physical appearance; and to various body systems, the sensory organs, and thermoregulation

•Discuss risks and nursing considerations associated with age-related changes

•Identify signs of and nursing interventions for older adults with hearing impairment

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IntroductionIntroductionIntroductionIntroduction•Changes of aging highly individualized

•Changes also different in various body systems of the individual

•Changes influenced by:

– Genetic factors, environment, diet, health, stress, and lifestyle choices

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Changes in the Body: CellsChanges in the Body: CellsChanges in the Body: CellsChanges in the Body: Cells• Changes start at

cellular level

• Cell numbers reduced

• Decreased lean body mass

• Increased total body fat

• Decreased fluid (cells)

• Risk for dehydration

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Changes in the Body: Changes in the Body: Physical AppearancePhysical AppearanceChanges in the Body: Changes in the Body: Physical AppearancePhysical Appearance• Begins 4th decade of

life

• Hair loss, gray hair, & wrinkles

• Reduced subcutaneous body fat

• Reduced tissue elasticity

• Reduced skin-fold thickness

• Decrease in stature

Figure 5-1, p. 53

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Ectropion of EyelidsEctropion of EyelidsEctropion of EyelidsEctropion of Eyelids

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Elongated EarsElongated EarsElongated EarsElongated Ears

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Checking Skin Turgor?Checking Skin Turgor?Checking Skin Turgor?Checking Skin Turgor?

Forehead, collarbone, or sternum Forehead, collarbone, or sternum (elder client)(elder client)

Not on back of hand or forearm Not on back of hand or forearm for an elder clientfor an elder client

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Changes in the Body: Changes in the Body: Respiratory SystemRespiratory SystemChanges in the Body: Changes in the Body: Respiratory SystemRespiratory System• Reduction respiratory

activity

• Increased rigidity of thoracic cage

• Kyphosis

• Increased anterior-posterior diameter of chest

• Blunted cough reflex, reduced cilia

• Less lung expansion

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Changes in the Body: Changes in the Body: Respiratory SystemRespiratory SystemChanges in the Body: Changes in the Body: Respiratory SystemRespiratory System• Increased residual

volume (increased air remaining in lungs after the most complete expiration possible)

• Reduced vital capacity (decreased capacity to inhale, hold, & exhale breath)

• High risk for respiratory infection (pneumonia)

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Lung Capacity DecreasesLung Capacity DecreasesLung Capacity DecreasesLung Capacity Decreases

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Figure 5-2, p. 53

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Question Question Question Question •Which of the normal age-related changes in

the respiratory system can increase the risk of infection in the older adult population?

– A. Decrease in the anterior-posterior diameter of the chest

– B. Increased strength of the thoracic musculature

– C. Increase in residual volume and reduction in vital capacity

– D. Decreased calcification of costal cartilage

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Changes in the Body: Changes in the Body: Cardiovascular SystemCardiovascular SystemChanges in the Body: Changes in the Body: Cardiovascular SystemCardiovascular System• Heart size unchanged (in

absence of pathology)

• Valves thick & rigid

• Heart muscle loses efficiency

– Reduced cardiac output under physiologic stress

• Reduced elasticity of blood vessels

• Increased peripheral resistance

– HTN not normal part of aging

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Normal Changes of Cardiac Normal Changes of Cardiac OutputOutputNormal Changes of Cardiac Normal Changes of Cardiac OutputOutput

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Reduced cardiac output Reduced cardiac output under physiologic stressunder physiologic stressReduced cardiac output Reduced cardiac output under physiologic stressunder physiologic stress

19Figure 5-3, p. 54

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Changes in the Body: Changes in the Body: Gastrointestinal SystemGastrointestinal SystemChanges in the Body: Changes in the Body: Gastrointestinal SystemGastrointestinal System• Tooth loss (edentulism) not a normal part of aging

• Decreased taste sensation (dysgeusia)

• Decreased saliva (xerostomia)

• Decreased hydrochloric acid (achlorhydria)

• Increased risk: aspiration, indigestion, & constipation– Constipation: fiber, fluids, & exercise

• Decreased esophageal, gastric, & intestinal motility

• Atrophy: small & large intestines

21Figure 5-4, p. 56

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QuestionQuestionQuestionQuestion•Is the following statement true or false?

•Atrophy of the small and large intestine, with fewer cells present on the absorbing surface of the intestinal wall, causes certain vitamins and minerals to have a decreased rate of absorption

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Changes in the Body: Urinary Changes in the Body: Urinary SystemSystemChanges in the Body: Urinary Changes in the Body: Urinary SystemSystem• Reduction renal blood

flow & filtration

• Reduced bladder capacity– Urinary frequency,

urgency, & nocturia common

– UTI = confusion

• Incontinence not a normal part of aging

24Figure 5-5, p. 57

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QuestionQuestionQuestionQuestion•Which symptom in adults 80 years of

age and older is most indicative of a urinary tract infection?

• (A) Confusion

• (B) Dysuria

• (C) Fever

• (D) Frequency

• (E) Hematuria

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Changes in the Body: Changes in the Body: Reproductive SystemReproductive SystemChanges in the Body: Changes in the Body: Reproductive SystemReproductive System•Male:

– Reduction sperm count

– Prostatic enlargement

•Female:

– Atrophy

– Estrogen depletion

28Figure 5-6, p. 58

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Changes in the Body: Changes in the Body: Musculoskeletal SystemMusculoskeletal SystemChanges in the Body: Changes in the Body: Musculoskeletal SystemMusculoskeletal System• Atrophy of muscles

• Tendons shrink & harden

• Reduction in bone mineral & mass

• Loss of height

• Joint activity & motion

• Increased risk fractures

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Figure 5-7, p. 59

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Changes in the Body: Changes in the Body: Nervous SystemNervous SystemChanges in the Body: Changes in the Body: Nervous SystemNervous System• Reduction: nerve cells,

cerebral blood flow, & metabolism

• Slower reflexes, delayed responses, & changes in balance

– Increased risk falls

• Nervous system affected by all other body systems

• Changes: sleep patterns (stages III & IV)

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Figure 5-8, p. 60

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QuestionQuestionQuestionQuestion•Which of the following is a normal age-related change of the nervous system?

• A. Decline in the weight of the brain

• B. Increase in cerebral blood flow

• C. Stage I and II sleep are interrupted

• D. Higher nerve conduction velocity

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Changes in the Body: Changes in the Body: Sensory Organs— VisionSensory Organs— VisionChanges in the Body: Changes in the Body: Sensory Organs— VisionSensory Organs— Vision• Presbyopia – normal

change of aging

• Narrowing of visual field; decreased peripheral vision

• Pupil less responsive to light

• Potential for macular degeneration

• Common eye disorders in the elderly are NOT normal: cataracts, glaucoma, macular degeneration, & retinopathy

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Changes in the Body: Changes in the Body: Sensory Organs— Vision Sensory Organs— Vision (cont’d)(cont’d)

Changes in the Body: Changes in the Body: Sensory Organs— Vision Sensory Organs— Vision (cont’d)(cont’d)• Opacification/

yellowing of lens: potential for cataracts

• Distortion in depth perception

• Dry eyes

• Arcus senilis – white/gray ring around cornea

• Decline visual acuity

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QuestionQuestionQuestionQuestion•Normal age-related changes in vision

include which of the following?

• (A) Difficulty focusing on far-away objects

• (B) Greater difficulty seeing objects in dim light

• (C) Greater ease with seeing objects up close

• (D) Blurry vision from increased lacrimation

• (E) A gradual loss of central vision

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Changes in the Body: Changes in the Body: Sensory Organs— HearingSensory Organs— HearingChanges in the Body: Changes in the Body: Sensory Organs— HearingSensory Organs— Hearing• Incidence

• Causes: age-related changes; loud noises; diseases; trauma; medications

– Ototoxic medications: aminoglycoside abx; loop diuretics; aspirin (review, p. 370)

• Inner ear problems

• Damage to 8th cranial nerve

• Tinnitus

• Alteration in equilibrium (balance)

• Presbycusis (sensorineural loss)

• Accumulation of cerumen; impaction (conductive loss)

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Presbycusis (p. 62)Presbycusis (p. 62)Presbycusis (p. 62)Presbycusis (p. 62)• Part of normal aging – most common cause of hearing loss in

elderly

• Characteristics: bilateral, symmetric, progressive

• 75% people over age 60

• Sensorineural loss

– Loss of hair cells in cochlea

– Degradation of neurons

• Gradual, bilateral, impaired ability to hear high-pitched tones

– High-pitched sounds such as "s" or "th" are hard to distinguish

– Unable to distinguish directions of sound

• No interventions to slow progression

• Rarely causes severe hearing loss/ deafness

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Cerumen ImpactionCerumen ImpactionCerumen ImpactionCerumen Impaction•One of most common, reversible causes of

conductive hearing loss in elderly adults

•35% community-residing older adults

•Can greatly affect hearing

•Feeling of fullness, itching in ear canal

•Recommended aural hygiene– Gentle cleaning of auricles

– Use of cotton-tipped applicators to cleanse ear canal NOT recommended

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Lavage or Irrigation to Lavage or Irrigation to Remove CerumenRemove CerumenLavage or Irrigation to Lavage or Irrigation to Remove CerumenRemove Cerumen

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Care of the Person With a Care of the Person With a Hearing DeficitHearing DeficitCare of the Person With a Care of the Person With a Hearing DeficitHearing Deficit•Encourage audiometric testing

– May not be age-related; could be treatable

•Learning to live with hearing deficit

•Emotional reactions to hearing problems

•Nursing interventions (review, p. 372)

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Hearing AidsHearing AidsHearing AidsHearing Aids•Hearing Aid Care Hearing Aid Care Box 26-3 (review, p.

372)

•Hearing aids benefit some, not all

•Examination by otologist

•Purchase only by prescription

•Hearing improves but does not return to normal

•Difficulties with hearing aid

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QuestionQuestionQuestionQuestion•It is more difficult for older people to hear:

• (A) High pitched consonants

• (B) Low pitched consonants

• (C) High pitched vowels

• (D) Low pitched vowels

• (E) All low frequency sounds

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Changes in the Body: Changes in the Body: Sensory Organs— Smell & Sensory Organs— Smell & TasteTaste

Changes in the Body: Changes in the Body: Sensory Organs— Smell & Sensory Organs— Smell & TasteTaste•Loss of ability to

smell

•Altered sense of taste (dysgeusia)

•Reduction in tactile sensation

•Potential risk related to safety issues

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Changes in the Body: Changes in the Body: Endocrine SystemEndocrine SystemChanges in the Body: Changes in the Body: Endocrine SystemEndocrine System• Decreased thyroid

• Decreased ACTH, glucocorticoids, estrogen, testosterone

• Delayed & insufficient release of insulin

• Decreased tissue sensitivity to insulin

• Reduced ability to metabolize glucose– Higher blood glucose

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Changes in the Body: Changes in the Body: Integumentary SystemIntegumentary SystemChanges in the Body: Changes in the Body: Integumentary SystemIntegumentary System•Skin less elastic,

more dry, & more fragile

•Age spots (solar lentigo)

• Increased skin cancer

•Thinning & graying of hair

•Fingernails longitudinal ridges

•Reduced sweat gland

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Changes in the Body: Changes in the Body: Immune SystemImmune SystemChanges in the Body: Changes in the Body: Immune SystemImmune System•Depressed immune response:

– Decreased fever response

– Thymus gland shrinks, T-cell activity declines

– Decline in cell-mediated immunity

– Increased risk for infection, cancer

– Potential for reactivation of dormant varicella-zoster (shingles) & tuberculosis

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QuestionQuestionQuestionQuestion•Because illness in older adults is complicated

by the normal changes of aging and multiple chronic conditions, many older adults do not display the usual signs and symptoms of illness. Atypical presentation of illness in older adults includes all of the following EXCEPT:

• (A) Anorexia

• (B) Cough

• (C) Confusion

• (D) Falls

• (E) Incontinence

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Changes in the Body: Changes in the Body: ThermoregulationThermoregulationChanges in the Body: Changes in the Body: ThermoregulationThermoregulation

•Lower normal body temperatures

•Rectal most reliable

•Reduced ability to respond to cold temperatures

•Differences in response to heat

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QuestionQuestionQuestionQuestion•Is the following statement true or false?

•Mean body temperatures of the older adult range from 96.9°F to 98.3°F orally.

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Changes in the MindChanges in the MindChanges in the MindChanges in the Mind•Psychological changes – explore causes

•Personality remains consistent

•Changes in memory

•Intelligence & aging

•Learning ability & aging

•Attention span

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Nursing Implications of Nursing Implications of Age-Related ChangesAge-Related ChangesNursing Implications of Nursing Implications of Age-Related ChangesAge-Related Changes•Understanding aging changes essential for

competent gerontological nursing practice

•Health promotion

•Acknowledgment of factors altering function with aging

•Emphasis on capabilities and assets

•Know– Table 5-1 Table 5-1 (pp. 66-67)

– pp. 370-371 (interventions for hearing interventions for hearing problemsproblems)

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QuestionQuestionQuestionQuestion•When talking with elders with high-

frequency hearing loss, the nurse should:

•A. Raise the voice or shout

•B. Face the client when talking

•C. Avoid using hand signals

•D. Do not talk directly into the ear

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QuestionQuestionQuestionQuestion•An elder client complains to the nurse

that he is having difficulty seeing colors. To assist the client in seeing colors better, the nurse should suggest increased use of which of the following colors?

•A. Blue

•B. Green

•C. Violet

•D. Red

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QuestionQuestionQuestionQuestion•The teaching plan for an elder client with

decreased taste and smell sensation would include which of the following (select all that apply):

•A. Add more spices and herbs to food

•B. Serve food attractively

•C. Add salt and sugar to food as needed

•D. Limit consumption of fluids

•E. Maintain adequate diet intake

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QuestionQuestionQuestionQuestion•Which of the following is an age-related change in the neurologic system?

•A. Increased intracranial pressure

•B. Prolongation of REM sleep

•C. Mild confusion

•D. Hypertonic reflexes

•E. Delayed response to stimuli

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QuestionQuestionQuestionQuestion•Nursing interventions for the drier oral

cavity that occurs with aging includes which of the following?

•A. Have patient drink before swallowing tablets

•B. Discourage fluids during meals

•C. Lemon and glycerin swabs

•D. Encourage mouth wash rinses